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A Guide for Aorto-Iliac PAD

A Guide for Aorto-Iliac PAD

Aorto-iliac peripheral arterial disease (PAD) is a serious condition in which blood flow to the lower extremities is blocked by atherosclerotic plaque. These blockages can significantly reduce patients’ quality of life (QOL) by limiting blood flow to the legs, causing pain with walking and, in rare cases, causing limb loss. “Aorto-iliac arterial occlusive disease is common and may cause a spectrum of chronic symptoms, ranging from intermittent claudication to critical limb ischemia,” explains Andrew J. P. Klein, MD, FACC, FSCAI. Helpful Guidance The American College of Cardiology and American Heart Association (ACC/AHA) published guidelines that recommend aorto-iliac interventions in patients with lifestyle limiting claudication where the risk-benefit ratio of the intervention is favorable. These guidelines note that endovascular intervention may be considered as a first-line treatment before or in addition to medical therapy and exercise in select cases of aorto-iliac occlusive disease due to its high success rates. In 2014, the Society for Cardiovascular Angiography and Interventions (SCAI) issued new anatomic, clinical, and technical guidance for the treatment of aorto-iliac PAD. The consensus paper—published in Catheterization and Cardiovascular Interventions—builds on the existing ACC/AHA guidelines for treating PAD. It is the first in a series of recommendations developed by SCAI to address PAD. The other parts of the series address femoropopliteal and infrapopliteal PAD as well as renal artery stenosis. “This consensus is a first stake in the ground to specifically address the treatment of aorto-iliac PAD with regards to what is appropriate, what may be appropriate, and what is rarely appropriate,” says Dr. Klein, who was lead author of the SCAI consensus paper (Table 1). The document was developed...
The ABI: Standardizing Measurements & Interpretations

The ABI: Standardizing Measurements & Interpretations

When the ankle-brachial index (ABI) emerged in 1950, it was initially proposed for use as a noninvasive diagnostic tool for lower-extremity peripheral artery disease (PAD). Since then, studies have shown that the ABI is an indicator of atherosclerosis at other vascular sites, making it a useful prognostic marker for cardiovascular events and functional impairment, even in the absence of symptoms of PAD. In an issue of Circulation, the American Heart Association (AHA) released a scientific statement with standardized recommendations for measuring and monitoring the ABI. The recommendations provide protocols and thresholds for use in PAD and cardiovascular risk prediction, according to Michael H. Criqui, MD, MPH, FAHA, who co-chaired the writing committee that developed the scientific statement. “A lack of standards for measuring and calculating the ABI can lead to discrepancies that can significantly impact both prevention and treatment of cardiovascular disease,” he says. “The estimated prevalence of PAD may vary substantially according to the mode of ABI calculation.” Reducing Variation in ABI Technique Recent studies have revealed that techniques for performing the ABI vary from clinician to clinician. Several variables have been identified, including the position of patients during measurement, the sizes of the arm and leg cuffs, and the method of pulse detection over the brachial artery and at the ankles. Other variables include whether the arm and ankle pressures were measured bilaterally, which ankle pulses were used, and whether a single measure or replicate measures were obtained. Several recommendations have been endorsed by the AHA for measuring the ABI (Table 1). “These recommendations can serve as a guide to ensure that clinicians are measuring the ABI...

Medical Therapy Matters Prior to Interventions in PAD

Research from Michigan suggests that use of statins and aspirin prior to percutaneous revascularization among patients with peripheral arterial disease, or PAD, appears to reduce the number of peripheral vascular events by more than half when measured at 6 months. The authors noted, however, that appropriate medical therapy—which also includes abstinence from smoking—was underutilized in this population. Abstract: Circulation: Cardiovascular Interventions, December 11, 2012...

Statin Non-Adherence & Treatment Intensification

A review of more than 125,000 patients on stable statin therapy suggests that nearly half (44%) of those who had their treatment intensified were non-adherent to their treatment. When compared with adherent patients, those who were not were 30% more likely to have had their statin therapy intensified. Those with statin therapy intensification were more likely to be younger, female, and have coronary artery disease, diabetes, hypertension, dyslipidemia, stroke, peripheral arterial disease, heart failure, or depression. Abstract: American Journal of Cardiology, November 15,...
CVD Risk Factors & PAD

CVD Risk Factors & PAD

Smoking, hypertension, hypercholesterolemia, and type 2 diabetes appear to be the cardiovascular (CVD) risk factors mostly associated with development of clinically significant peripheral artery disease (PAD), according to results of a prospective study of nearly 45,000 United States men. At PAD diagnosis, 96% of men had at least one of these CVD risk factors. Among the findings:             Abstract: JAMA, October 24,...
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